I’ve been listening to some of the campaign speech summaries recently, both on the Republican and Democratic sides. A common theme is a stagnant middle class with shrinking jobs and a growing wage gap compared to the wealthiest few percent of Americans. The politician’s silence on a key set of facts...
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In a post I wrote about 7 months ago, I stated that it was too soon to tell what the real effect of Obamacare on the overall cost of healthcare/health insurance was going to be. Unstable membership populations, loss-leader offerings by insurance companies, and other factors means that it will probably take...
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The Texas Academy of Family Physicians recently published a piece I wrote for them on the preliminary results of our P4 curricular innovations at my day job: the John Peter Smith Family Medicine residency. Briefly, the P4 project (Preparing the Personal Physician for Practice) was a national experiment where 14 family...
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Hello again!  I haven’t written anything in a while. No big worries. I moved recently (same town, same neighborhood), but the remodel of the new house has been a mis-adventure and I’ve been living out of boxes and breathing dust for over a month. Things are kind of finally settling down....
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Atul Gawande, MD, who is the doctor-writer who has published frequently in the New Yorker and has published several well-regarded books, has written a great piece in the latest New Yorker. It’s called Overkill. It’s basic premise is that he went back to McAllen, TX to see how things were going 5...
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The best primary care-based research comes out of Europe, where countries have medical research budgets that actually fund primary care research. The U.S. has no equivalent funder. Therefore, American family physicians must often look overseas for answers to their daily clinical questions. Does screening for diabetes make any difference? A recent study...
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A lot of healthcare system pundits including the current leadership of the American Academy of Family Physicians feels that fee-for-service payment is the root of all healthcare waste. Obviously, I disagree. Their line of thinking is based on the existing evidence that there are too many joint replacements, cardiac stents, cardiac tests, etc., because...
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Do you like to take pills? I don’t. I bet most family physicians would say they have some patients who should be better at taking pills and some who love taking pills too much. For people who don’t like taking pills, what would a trade-off look like? If you were given...
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A study was recently published in the New England Journal of Medicine about the cost-effectiveness of treating hypertension based on the most recent JNC 8 guidelines. This study particularly caught my eye, because previous cost-effectiveness analyses found that screening and treating for hypertension did not save money. The upfront costs of...
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patients The American Heart Association (AHA) recently proposed new guidelines for all doctors to screen and treat for high cholesterol. For doctors and patients to follow this would result in a large increase in the number of Americans taking statins. One of the things I like about the new proposal is that...
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